Dr. Nath - Winging Scapula Injury Expert Specializing in Long Thoracic Nerve, Serratus Anterior Injury and Long Thoracic Nerve Decompression in the Texas Medical Center
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6400 Fannin St.
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Houston , TX 77030
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(713) 592-9900

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Brachial Plexus Forum

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Injury Causes

Surgical decompression and neurolysis appears to be an effective and rational treatment modality in specific instances where supraclavicular injury to the long thoracic nerve is identified. Risk factors for supraclavicular nerve injury include a history of vigorous athletic maneuvers with the affected extremity, lifting of heavy weights, and direct external pressure on the area as in deep massage.

Injury to the upper trunk of the brachial plexus is also associated with the proposed stretch or compression mechanisms causative of the injury. In terms of upper trunk pathology, the shoulder examination is somewhat unreliable, as the long- standing scapular instability will secondarily affect deltoid and spinati strength. However, biceps weakness to BMG 3 or 4 was invariably found in the current patient group, and this is direct evidence of upper trunk injury.

long thoracic nerve palsy

Anatomically, the long thoracic nerve and the upper trunk are intimately related; the long thoracic nerve occurs immediately posterior and lateral to the upper trunk. It is easy to understand that an axial load along the course of the brachial plexus will affect these structures both by direct stretch forces and by compression of the intramuscular scalene portions of the upper trunk and long thoracic nerve.

The relatively delicate structure of the long thoracic nerve is contrasted with the densely- composed upper trunk and predicts the consequences of trauma to each element: the upper trunk will exhibit lesser degrees of dysfunction than the long thoracic nerve given similarly applied forces.


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Dr. Nath is a specialist in: Brachial Plexus Injury (Erb's Palsy), Winging Scapula Injury (Long Thoracic Nerve Palsy),
Neurofibroma and Schwannomatosis Nerve Tumors, and Nerve Surgery to correct Impotence after Prostate Cancer Surgery